Indonesian strategy in reducing Aedes aegypty diseases in ASEAN economic community era

International Journal of Research in Medical Sciences Tosepu R et al. Int J Res Med Sci. 2015 Jul;3(7):1578-1582 www.msjonline.org pissn 2320-6071 eissn 2320-6012 Review Article DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20150232 Indonesian strategy in reducing Aedes aegypty diseases in ASEAN economic community era Ramadhan Tosepu 1,*, Devi Savitri Effendy 2, Hartati Bahar 2 1 Environmental Health Department, Public Health Faculty, Halu Oleo University, Indonesia 2 Public Health Faculty, Halu Oleo University, Indonesia Received: 03 May 2015 Revised: 05 May 2015 Accepted: 05 June 2015 *Correspondence: Ramadhan Tosepu, MPH. E-mail: adhan_lpmi@yahoo.co.id Copyright: the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. ABSTRACT Indonesia is one of the countries that has a very strategic role in the ASEAN region. The state of readiness of Indonesia in ASEAN Economic Community (AEC) 2015 will involve all elements of the society due to very large population. Economically, Indonesia should be able to compete with ASEAN countries, and human resources should also be prepared. On the other hand, shifts and movements of the people between countries will be increased, this could be a threat for the country. However, those who are ready with the human resources, it might be a positive value, otherwise, it might be a weakness for unprepared countries. AEC era is not only economic power that should be concerned, but also health problems that should be a priority. Nowadays, the Aedes aegypti cases are still high in Indonesia. This paper aims to describe the strategies to reduce the disease, which also be a focus of government. Keywords: ASEAN Economic Community, Aedes aegypti INTRODUCTION The main concept of the ASEAN Economic Community (AEC) is to create ASEAN as a single market and production-based unity, which there is a free low on goods, services, factors of production, investment and capital as well as the elimination of tariffs for trade between countries of ASEAN. AEC is expected to reduce poverty and economic disparities between the member countries through a number of mutually beneficial cooperation. 1 The presence of the AEC could help the powerlessness of ASEAN countries in the global competition of the world economy by establishing a single market based in Southeast Asia. 2 In the era of AEC, the shift of people from one country to another will be very open and free. 2 In terms of health, it will have a great impact because people are susceptible to the disease that will be easily infected. Moreover, Indonesia is still facing a high variety of diseases such as Aedes aegypti, the solution of this disease should be serious and involve many parties. On the other side, one of health problems in Indonesia until now is Dengue, which the number of patients is progressively increased as well as its virus distribution. 3 This disease is found in almost all parts of the world, especially in the tropical and subtropical countries, as both endemic and epidemic disease, 4 and the dengue virus is the cause of Aedes aegypti disease. Aedes aegypti disease by the dengue virus will be into the circulation of humans through the bite of mosquitoes of the genus of Aedes, 5 for instance, Aedes aegypti or Aedes albopictus. This disease can occur throughout the year and affect all age groups. However, it is associated with the environment and people behavior. 6 Therefore, to control and manage the environment and change the people behavior are needed. International Journal of Research in Medical Sciences July 2015 Vol 3 Issue 7 Page 1578

The control of Aedes aegypti disease is a series of preventing and controlling activities to break the chain of disease transmission by Aedes aegypti mosquitoes and ways to eradicate Aedes aegypti mosquito larvae. 7 However, there are two kind of activities need to be implemented, namely 1) The prevention of Aedes aegypti, which is a series of actions taken before any case of Aedes aegypti occured, and 2) Eradication when Aedes aegypti already occurred. This paper aimed to discuss about the prevention strategies to reducing Aedes aegypti in Indonesia. METHODS Secondary data analysis from literature review was conducted in this study, whis is from database such as Scopus, DOAJ, Google Scholar, and also from grey literatures from the report of Ministry of Health Indonesia, Indonesian Public Health Assosiation (IPHA), Statistic of Indonesia, and others sources. RESULTS AND DISCUSIONS Population of Indonesia Indonesia consists of 33 provinces with a very diverse population distribution among the provinces with the other provinces. From the Table 1, it could be seen that Jawa Barat Province is the highest population of 43.053.732 and the province of Papua Barat is a province with the less population, 7.604.22. However, year by year, Indonesia population increased gradually, from 119.208 229 population in 1971, to 237.641 326 population in 2010. Table 1: Population of Indonesia by Province 1971, 1980, 1990, 1995, 2000 and 2010 8. Provinces Populations 1971 1980 1990 1995 2000 2010 Aceh 2008595 2611271 3416156 3847583 3930905 4494410 Sumatera Utara 6621831 8360894 10256027 11114667 11649655 12982204 Sumatera Barat 2793196 3406816 4000207 4323170 4248931 4846909 Riau 1641545 2168535 3303976 3900534 4957627 5538367 Jambi 1006084 1445994 2020568 2369959 2413846 3092265 Sumatera Selatan 3440573 4629801 6313074 7207545 6899675 7450394 Bengkulu 519316 768064 1179122 1409117 1567432 1715518 Lampung 2777008 4624785 6017573 6657759 6741439 7608405 Kepulauan Bangka Belitung - - - - 900197 1223296 Kepulauan Riau - - - - - 1679163 Dki Jakarta 4579303 6503449 8259266 9112652 8389443 9607787 Jawa Barat 21623529 27453525 35384352 39206787 35729537 43053732 Jawa Tengah 21877136 25372889 28520643 29653266 31228940 32382657 Di Yogyakarta 2489360 2750813 2913054 2916779 3122268 3457491 Jawa Timur 25516999 29188852 32503991 33844002 34783640 37476757 Banten - - - - 8098780 10632166 Bali 2120322 2469930 2777811 2895649 3151162 3890757 Nusa Tenggara Barat 2203465 2724664 3369649 3645713 4009261 4500212 Nusa Tenggara Timur 2295287 2737166 3268644 3577472 3952279 4683827 Kalimantan Barat 2019936 2486068 3229153 3635730 4034198 4395983 Kalimantan Tengah 701936 954353 1396486 1627453 1857000 2212089 Kalimantan Selatan 1699105 2064649 2597572 2893477 2985240 3626616 Kalimantan Timur 733797 1218016 1876663 2314183 2455120 3553143 Sulawesi Utara 1718543 2115384 2478119 2649093 2012098 2270596 Sulawesi Tengah 913662 1289635 1711327 1938071 2218435 2635009 Sulawesi Selatan 5180576 6062212 6981646 7558368 8059627 8034776 Sulawesi Tenggara 714120 942302 1349619 1586917 1821284 2232586 Gorontalo - - - - 835044 1040164 Sulawesi Barat - - - - - 1158651 Maluku 1089565 1411006 1857790 2086516 1205539 1533506 Maluku Utara - - - - 785059 1038087 Papua Barat - - - - - 760422 Papua 923440 1173875 1648708 1942627 2220934 2833381 Indonesia 119.208.229 147.490.298 179.378.946 194.754.808 206.264.595 237.641.326 Note: Including non permanent resident (homeless people, sailor, boat people and remote area community). Source: 1971, 1980, 1990, 2000 Population Census, and 1995 Intercensal Population Census International Journal of Research in Medical Sciences July 2015 Vol 3 Issue 7 Page 1579

Table 2: Distribution of Dengue fever in ASEAN Country. Country Dengue fever apparent and cases (Million) 10 Brunei Darussalam 12.732 Cambodia 0.4 Indonesia 7.6 Lao PDR 0.1 Myanmar 1 Philippines 3.1 Singapore 0.2 Thailand 1.9 Vietnam 2.6 Conditions of Aedes aegypty Disease in Indonesia 9 In line with this, there were 26 provinces (78.8%) that achieved the morbidity of Aedes aegypty in 2013 (see Figure 2). The high Incidence Rate (IR) was in Bali, which about 168, 48 cases, while in DKI Jakarta was around 104.04 cases, and DI Yogyakarta was only 95.99 per 100,000 population. On the other hand, death due to Aedes aegypty was categorized as high if Case Fatality Rate (CFR)> 2%, and in 2013, there were three provinces having a high CFR includes Jambi, Bangka Belitung Islands, and East Nusa Tenggara. Therefore, these three provinces still need to improve the quality of health services as well as quality and quantity of health human resources in hospitals and health centers (doctors, nurses, and others), and improve the facilities, particularly the supporting diagnostics and treatment. Nationally, the target of morbidity Aedes aegypty is 53 per 100,000 population or less. Until 2013, the morbidity Aedes aegypty in Indonesia was recorded around 45.85 per 100,000 population. It means the number has reached the target set, while the mortality Aedes aegypty was also decreased, from 41.30% in 1968 to 0.77% by 2013, based on CFR. Dengue Fever Apparent Cases in ASEAN Country Figure 1: Condition of Aedes aegypty in Indonesia by years. In 2013, the number of patients of Aedes aegypty were reported approximately 112 511 cases with 871 deaths of people (Incidence Rate/morbidity which was 45.85 per 100,000 population and CFR/mortality of 0.77%). It was higher when compared to the in 2012, which approximately 90,245 cases with IR 37.27. Meanwhile, the target of Strategic Plan of the Ministry of Health for morbidity Aedes aegypty in 2013 is 52 per 100,000 population. Hence, Indonesia has thus reached the target of the Strategic Plan in 2013. Cases Aedes aegypti in Indonesia by Provinces 9 Figure 2: Cases Aedes aegypty in Indonesia by province. Despite having morbidity and mortality of Aedes aegypty, Dengue fever cases in the ASEAN region are also spread out evenly. Indonesia is the highest country having 7.6 million cases in distribution, while Brunei Darussalam is the lowest country in distribution, which is only12.732 thousands cases. Therefore, Indonesian government need to do a great effort in reducing dengue fever, especially Aedes aegypty that a main cause of dengue fever. The Role of Civil Society Aedes aegypty is a public health problem that is difficult to overcome. Disease prevention and eradication of Aedes aegypty is a shared responsibility between the government and society. 11 Duties and responsibilities of the government in efforts to eradicate the disease Aedes aegypty include making policy and strategic plan Aedes aegypty disease prevention, eradication developing technology, develop guidelines eradication, provide training and technical assistance, conduct counseling and health promotion and community mobilization. 12 Eradication program of Aedes aegypty vector actually emphasis on the cleaning of Aedes mosquito larvae, 5 this requires the involvement of all levels of society in order the eradication program could be longer and more sustainable. The Awareness Model in society can be more effective if being implemented by health provider in society, especially in disctrics and subdistricts. This program focuses on the process of increasing knowledge and awareness of the public about the importance of healthy living. The knowledge will include the information about Aedes aegypti breeding places, such as International Journal of Research in Medical Sciences July 2015 Vol 3 Issue 7 Page 1580

in the shelters of clean water or the tub of raining water, water storage tanks, flower vases, cans or plastic bag former, on the top floor of the open building, house gutters, bamboo fences, fruit peel rind like rambutan, coconut shells, old tires, and all forms of containers that can hold water. 4 However, many factors cause of the disease such as environment, behavior of society, health services and heredity. But, there are many things underlie the difficulty of eradicating Aedes aegypty in Indonesia, including lack of knowledge and awareness of society to behave in a healthy life and pay attention to the environment, particularly the environment of mosquito breeding sites. 6 This is due to lack of community involvement in tackling the issue of Aedes aegypty and dissemination of government to the public about how to eradicate the Aedes aegypty and prevention appropriate and in accordance with the state of the surrounding environment. The role of public health professional organizations In Indonesia, there is Jumantik Child that other countries might not have. It is primary school pupils were selected to be trained to understand the basics of dengue prevention, to share knowledge about environment to friends and family and do activities to eradicate mosquito e in school and home. Through this Jumantik Child action, children are trained to no longer be a victim of dengue fever but able to become agents of change and inspiration for the environment. 13 Therefore, mosquito eradication activities are conducted by society and government regularly and continuously to prevent dengue fever by eradicating the mosquito to mosquito larvae 14 either by chemical means, biological way (to keep the fish eating larvae or bacteria), or by physical activities consisting of activities draining, shut down, bury. 15 The role of government. The government has four pillars of the strategy in reducing Aedes aegypty. First, strengthen the observation of the case and vector, which is supported by adequate laboratory; Second, strengthen the management of patients in hospitals, health centers and clinics; Third, improve vector control efforts in an integrated manner; Fourth, strengthen partnerships with various parties in the prevention and control of Aedes aegypty disease. However, in order to support the implementation of the government strategy, quality development of human resources are needed to reduce Aedes aegypty. In line with this, the scope of eradicating Aedes aegypty in Indonesia include Aedes aegypty Epidemiology, Surveillance Aedes aegypty case, Surveillance and Control of Vectors Aedes aegypty, Aedes aegypty Case Management, Research Epidemiology, Prevention Focus and Countermeasures outbreaks Aedes aegypty, Operating Equipment and Materials Aedes aegypty Vector Control, Planning Supervision 16 and Control of Aedes aegypty, Health Promotion In Control Aedes aegypty. 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